Bleeding from most injuries can be stopped by applying direct pressure to the injury. This keeps from cutting off the blood supply to the affected limb. A wound that is deep, bleeding heavily, or has blood spurting from it (caused by bleeding from an artery), may not clot and may not stop bleeding. The first step is to stop the bleeding, this is called hemostasis.

If the wound is such that a person is going to bleed out, this becomes emergent and is first in the primary survey using the MARCH protocol, where M stands for massive hemorrhage. Direct pressure is the first step in stopping any blood loss. The application of direct pressure controls bleeding from most wounds. Use the cleanest materials available and apply direct pressure to the source of bleeding. This may take several minutes. Larger wounds may require direct pressure for a longer period of time. Scalp wounds may require continuous pressure.

Elevate the wound above the heart and apply firm pressure with a clean compress (such as a clean, heavy gauze pad, washcloth, T-shirt, or sock) directly on the wound. Call out for someone to get help, or call EMS yourself. Do not remove a pad that is soaked through with blood; you will disturb any blood clots that have started to form to help stop the bleeding. If blood soaks through, place another pad on top of the soaked one and continue applying direct pressure.

If the wound is large and deep, try to pack the cloth or gauze into the wound. Apply continuous pressure with both hands directly on top of the bleeding wound.

• Push down as hard as you can.

• Hold pressure to stop bleeding.

• Continue pressure until relieved by medical responders.

Learn more in our Stop The Bleed course, where we go into more detail and show you the best tecnique to apply direct pressure to a bleeding wound.